Fungal nail infection (ringworm of the nails)

Reviewed by Professor James Ferguson, consultant dermatologist

What is ringworm of the nails?

Ringworm of the nail is due to a fungal infection (dermatophyte) similar to the type that causes athlete's foot.

Other scientific terms for ringworm of the nails are: tinea unguium, onychomycosis or dermatophytosis unguium. The fungi that cause ringworm are able to feed on keratin - the main protein in nails, hair and the outer layer of the skin.

How do you get ringworm of the nails?

Ringworm of the nails can occur directly in the nail itself or from an untreated fungal infection of the foot. Fungal infection of the foot can also spread and grow into the nail.

What are the symptoms?

A whitish thickening of the nail and nail-bed.

The nail thickens, discolours and in advanced stages the nail may become destroyed.

Who is at most risk?

Young people, especially if they wear trainers.

Sportspeople.

People who are required to wear close-fitting rubber footwear for their work.

People who live in a warm, humid climate.

How does the doctor make a diagnosis?

Usually the diagnosis can be made from the clinical picture alone. A smear or scrape may be taken for microscopic examination and culture in the laboratory to identify the type of fungus.

How is ringworm of the nails treated?

Ringworm of the nails is best treated with antifungal tablets, such as terbinafine, and/or local fungicides, such as amorolfine or tioconazole nail solutions. The treatment may need to be continued for months.

Outlook

Ringworm of the nails can be difficult to cure and may return even after treatment has ended.

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